Prostate Cancer
Prostate cancer primarily affects men over the age of 45 years. The treatment of this cancer is usually surgery (radical prostatectomy) or radiation therapy (external beam or brachytherapy). Newer treatments include cryotherapy and treatment for advanced prostate cancer usually involves androgen deprivation. All have significant effects on erectile functioning.
Radical prostatectomy involves the surgical removal of the entire prostate gland. The cavernous nerves lie along the outside of the gland, one on each side. These nerves are responsible for causing erections. During the surgery, depending on the extent of the cancer, most surgeons will attempt to �spare� these nerves by dissecting them off the prostate gland. Nerve sparing may be bilateral or unilateral and some times, both nerve bundles have to be destroyed due to the presence of large tumour volume. Even with nerve sparing surgery, most men will experience erectile dysfunction after the surgery. Erections may return over time, up to five years later, however most men will need to use some form of treatment to help them have erections. The most common form of treatment is one of the
Following surgical removal of the prostate, men will no longer have ejaculate as the seminal vesicles are removed and the vas deferens is cut. They can however experience the sensation of orgasm even without erections. Radiation therapy also affects erectile functioning but usually one to two years after treatment. The onset of problems is usually slow and brachytherapy appears to have the least sexual side effects. Men who have external beam radiation are often older than those having surgery and so may already have noticed age-associated changes to their erectile functioning. Men who have had radiation therapy may also benefit from the various treatments listed in the previous section. Cryotherapy uses extreme cold to freeze the tissue of the prostate gland and in that way, destroy any cancer cells. It is quite difficult to control the depth of the freezing and therefore it is very hard to prevent the fragile nerves on the outside of the gland from freezing. Most men who have cryotherapy are unable to have erections. Androgen deprivation therapy is prescribed for men who either have more advanced prostate cancer or whose cancer has returned following surgery and/or radiation therapy. This treatment interferes with the production of testosterone by the testicles. Men on androgen deprivation therapy often find that they lose interest in sex and don�t really notice that they no longer have erections. Depending on how the treatment is given for, sexual interest and erectile capacity may or may not return. Erectile difficulties associated with the use of androgen therapy are more difficult to treat. The oral medications do not work well in this instance and the man may need to consider the vacuum pump or penile self-injection as these tend to be more effective.
Some couples find that they are more interested in non-penetrative sexual activities in the time after treatment and are not interested in taking medications to cause erections. This is a good alternative for many couples. Oral and manual sexual stimulation can be very satisfying for both partners. Many couples find it difficult to talk about sexual problems with each other and just let things slide. This can lead to strain and tension in the relationship and many couples end up living like roommates. This may be okay for some but others may find this very difficult. Some men or couples experience feelings of sadness when they face difficulties in their sex life. It is important for the person with cancer and/or their partner to tell a health care provider if they are having communication or sexual problems. There is help available but if the problem is not identified, nothing can be done to help.